California Children's Services
California Children’s Services (CCS) is California’s longest running children’s health care program starting in 1927. Holding true to the original doctrine of the program, CCS provides case management for 6,000 Kern County children with qualifying complex medical conditions. Additionally, CCS provides physical and occupational therapy at two clinics located at public schools. CCS children and their families are served by dedicated professionals that include: A physician Medical Consultant, Public Health Nurses, Physical and Occupational Therapists, Program Case Managers, and fiscal and clerical support staff.
CCS provides case management and funding for the diagnosis and treatment of qualifying medical conditions. Additionally, through its Medical Therapy Program, physical and occupational therapy are provided at Medical Therapy Units. Case management includes assisting families navigate the health insurance systems, coordinating medical care with specialists and children’s hospitals, and helping to solve challenges like transportation and transitions to adult care.
Your child may be eligible if he/she meets all four of the following requirements:
- Age – Your child must be under 21 years of age.
- Income – If your child is not already enrolled in Medi-Cal or the Medi-Cal Targeted Low-Income Children’s Program, your family income must be less than $40,000 per year, according to the adjusted gross income on your California income taxes. A child may be eligible when the family income is more than $40,000 if medical care for the child’s CCS condition is expected to cost the family more than 20 percent of the family’s yearly income.
- Residence – You must be a resident of the California county where you apply.
- Medical conditions – Only certain medical conditions are eligible for CCS. In general, CCS covers medical conditions that are physically disabling or require medical, surgical, or rehabilitative services.
Examples of Medical Conditions that May Be Covered by CCS
More specific criteria may be used to determine if your child’s medical condition is eligible for CCS coverage. Anyone can refer a child to CCS, including parents. All services must be approved ahead of time by CCS and be medically necessary.
Conditions Involving The Heart
- Diseases of the blood
- Diseases of the respiratory system
- Endocrine, nutritional, and metabolic diseases
- Diseases of the genito-urinary system
- Diseases of the gastrointestinal system
- Serious birth defects
- Diseases of the sense organs
- Diseases of the nervous system
- Diseases of the musculoskeletal system and connective tissue
- Severe disorders of the immune system
- Disabling injuries and poisonings requiring intensive care or rehabilitation
- Complications of premature birth
- Diseases of the skin and subcutaneous tissue
- Medically handicapping malocclusion
What are CCS benefits?
The benefits of CCS are:
- Medical care that the CCS program arranges and funds
- Assistance in getting to out-of-county medical appointments
- Therapy for eligible children
Case Management –Case management is determining medical eligibility, identifying your child’s medical needs, and helping you see special doctors and receive services to meet your child’s special health care needs. If your child has Medi-Cal or Healthy Families health care coverage and a CCS-eligible condition, CCS can coordinate your child’s medical care.
Diagnostic Services –A diagnostic evaluation to establish the presence of a CCS-eligible condition. CCS teams partner with you to coordinate your child’s medical care.
Treatment Services –Treatment services include medical services, medicines, equipment, or supplies that are medically necessary to treat your child’s CCS-eligible condition.
Special Care Centers –Special Care Centers provide comprehensive, coordinated health care to CCS clients with specific medical conditions.
Medical Therapy Program in Schools – The Medical Therapy Program (MTP) provides medically necessary physical and/or occupational therapy services to eligible children. These services are provided at Medical Therapy Units (MTUs) located in designated public schools.
California state law and regulations govern the CCS program. The state laws are found in the Health and Safety Code, Welfare and Institutions Code, and the Government Code. The regulations are found in the California Code of Regulations. These laws and regulations can be found in a county law library and on the Internet through the California Department of Health Care Services website.
CCS Call Center operations have temporarily changed.
- Clients and their families will be able to contact CCS administration with questions regarding their cases.
- Providers should check PEDI or CMS Net regarding SARs or to verify receipt of documents.
- Providers should continue to submit SARs electronically through the Children’s Medical Services Network (CMS Net) Provider Electronic Data Interchange (PEDI).
- If you have a PEDI account but need assistance logging into PEDI, please contact your organization’s PEDI liaison.
- To apply for PEDI online please visit https://cmsprovider.cahwnet.gov/PEDI/login.jsp. For assistance, please contact the State’s Helpdesk at email@example.com.
- Do not FAX duplicate SARs once they have already been submitted electronically simply because you do not see a prior authorization in the system.
- Pharmacies: Medi-Cal RX went live on January 1, 2022. Effective January 1, 2022 you will no longer be able to submit pharmacy SARs to CCS. For more information contact visit https://medi-calrx.dhcs.ca.gov/home/. You may also contact MediCalRxEducationOutreach@magellanhealth.com or call 1-800-977-2273.